- Receiving formula in the hospital
- The mother has changed her mind about breastfeeding
- The mother has concerns about milk supply
- Medical concerns
- Difficulties getting the baby latched to the breast
Is it the freezing cold that makes us hardier? Overall, Minnesota is quite a healthy state, especially for a Midwestern state. Compared to the rest of the country, we rank #1 in the nation for fewest days off for mental illness, and #3 for the fewest days off of work for physical illness. We are also #1 in the nation for fewest deaths from cardiovascular causes. Closer to the point, our babies are born at relatively higher birth weights than 45 other states, and we have a lower rate of infant mortality than many states (#12 in the nation). Only seven states have a better score for the fewest preterm births. (America's Health Rankings)
So it should come as no surprise with our great overall health and birth statistics that we also have relatively high overall breastfeeding rates. In 2016, mothers from Minnesota breastfed 90.1% of our babies at least once. Only 6 states have higher rates for ever-breastfed babies! While this is fabulous, there is still work to be done. While our exclusive breastfeeding rates at both three and six months are higher than the national average, it is still less than impressive that fewer than 1/3 of our babies (31.4%) are still exclusively breastfed at six months. Since many babies begin solids between the fourth and sixth month of age, this may not be particularly surprising. However, looking a bit earlier in life, just a little over half (53.9%) of Minnesota's babies are exclusively breastfed at a mere three months of age (CDC 2016 Breastfeeding Report Card), despite the fact that exclusive breastfeeding for 6 months provides most babies with the best start in life. Even the American Academy of Pediatrics, which has been a relatively muted in its support for breastfeeding throughout its years, published a statement in 2012 recommending again that babies should be exclusively breastfed for the first 6 months of life.
Let's look at local numbers! How do our local breastfeeding rates compare with state-wide rates? Compared to the state as a whole, Washington County is very supportive of breastfeeding. Washington County Public Health and Environment announced in 2013 that it was designated a Breastfeeding Friendly Health Department. An estimated 88% of hospital-born babies are breastfeeding upon discharge from Washington County hospitals. While not all in Washington County, the three HealthEast hospitals (St. John's, St. Joseph's and Woodwinds) are all relatively close to Washington County, and all three have the Baby Friendly Hospital designation. While about 90% of these babies are being breastfed upon hospital discharge, only about 40% of babies are being exclusively breastfed upon discharge. So clearly there is work to be done encouraging mothers to exclusively breastfeed and supporting them so that they are able to exclusively breastfeed, especially through the first week of baby's life.
7.1% of children living in Washington County, MN (an estimated 4,900 children) live below the poverty line; and of Washington County residents as a whole, 7.6% are unable to get adequate food. Pregnant and breastfeeding mothers, as well as infants and children without food security who qualify based on household income may participate in the county WIC (Women, Infants & Children) Nutrition Program.
In 2014 (the latest year with complete information), there were 905 babies in Washington County who were participating in the WIC (Women, Infants, and Children) Nutrition Program. Of these babies, an amazing 88.4% received some breastmilk, identical to the county statistics! By three months, the percentage of babies participating in the WIC Program who were receiving some breastmilk dropped to 44.8% -- half of the original number of breastfed babies.
Focusing even more locally (again in 2014) mothers of babies participating in WIC who resided in Lake Elmo, Stillwater, and Mahtomedi had impressive breastfeeding rates. 91.7% of the babies received some breastmilk, identical to the data from MN as a whole. 40.0% of the babies were still receiving some breastmilk at 3 months of age; 30.4% were still receiving some breastmilk at 6 months of age; and 23.0% were still receiving breastmilk at a year. As with Washington County mothers as a whole--locally, there is a drop of over half the number of breastfed babies in the first three months of life. After the first three months, breastfeeding rates continue to drop, but at a much slower pace.
A 2015 report about Minnesota mothers participating in WIC indicates that the most common predictors for weaning prior to 3 months include:
If baby received formula in the hospital, mother may assume the baby needs formula, or that it is just as good as breastmilk. While mothers will change their minds, it helps to stay the course if someone is supporting your original intention, and letting you know that while it may be difficult at first, breastfeeding does become much easier later on. Concerns about milk supply and getting baby latched are difficulties for which a trained breastfeeding counselor or lactation consultant can provide valuable assistance. Well-baby check-ups may not coincide with the time the mother is experiencing breastfeeding problems, and not all health care providers have the proper education and training to help breastfeeding mothers troubleshoot problems. Many mothers need help understanding how to make the transition from breastfeeding at home to the very different situation of providing baby with breastmilk after returning to work, a situation that often includes pumping or expressing her milk in less than ideal surroundings. Family and friends may not understand the importance of breastfeeding and may undermine her confidence or exert well-intentioned pressure to give formula. Mothers may not know that free breastfeeding support groups are available for help and support, or they may find it difficult to get to the support group on the day and time when it meets.
When I look at these statistics, for Minnesota as a whole, as well as for WIC participants, perhaps not surprisingly, my conclusion is that breastfeeding mothers need the MOST breastfeeding support during the first week (most will be discharged from the hospital within a week), but there is still a great need for support during the first three months of their babies' lives. This is why every mother who wants to breastfeed has a right to the support of a breastfeeding counselor. Breastfeeding counselors visit mothers at the hospital and make house calls, help mothers find solutions to breastfeeding difficulties so that they can reach their breastfeeding goals, and provide a consistent and easily accessible source of support and encouragement. If medical concerns about the baby or breastfeeding issues prove complex, the breastfeeding counselor is trained to refer the mother to a lactation consultant or other health care professional. The breastfeeding counselor has time to devote to the mother-baby that is difficult to find elsewhere.
Every mother has a right to a breastfeeding counselor at least for the first three months of her baby's life. How can we make that happen?
My first exposure to a ‘vetch’ was as a gardener, and I immediately recall my intense annoyance with this very hardy (read un-killable) legume. Turns out I should have had a little more respect for this tenacious invader, or at least for its amazing plant ‘cousin’, milk vetch.
Astragalus, also known as milk vetch and Huang-qi, is a legume native to China. There are over 1000 species in the Astragalus genus, but according to Richo Cech, author of Making Plant Medicine, the species Astragalus membranaceus and A. mongholicus are to be preferred for herbal medicine purposes, due to their superior efficacy compared to other astragalus species, so look for one of those if you want to try growing it yourself.
Astragalus membranaceus is believed to be safe for use during pregnancy, and indeed, is an herbal remedy with an amazing variety of indications that may be helpful during gestation. There is another astragalus species known as "locoweed" which is dangerous and has been associated with fetal malformations and miscarriages in animal studies; therefore, it is important to make sure to identify the correct species. Since astragalus is more potent than a nourishing herb, if you do decide to try astragalus, take the smallest effective dose. Short-term use only is recommended until more is known about the safety of A. membranaceus in pregnancy. Of course, it is always advisable that you consult with your health care provider before taking any herb during pregnancy.
Early pregnancy is notorious as a time when the expectant mother is astoundingly tired. Astragalus to the rescue! Astragalus helps to restore energy and improves an individual’s stamina. As if being exhausted isn’t enough, pregnant women often note that they are more susceptible to viruses, due to their diminished immune system functioning. Thankfully, astragalus is well known as an immune system booster. In fact, the only known medications with which astragalus interacts negatively are those designed to suppress the immune system, which, of course, most pregnant women will not be taking.
As pregnancy progresses, a woman’s body produces increasing amounts of progesterone, an essential hormone that helps her body maintain the pregnancy. However, progesterone has the effect of slowing digestion, which for some, can lead to flatulence. Thankfully for everyone, relief of gas is one of astragalus’s actions.
All those extra hormones, in addition to the greatly increased blood volume—normal during pregnancy—causes the expectant mom’s liver to work much harder. Astragalus supports liver functioning and is even believed to help restore liver damage. This makes astragalus an important herb for women at greater risk for pre-eclampsia, including moms with a personal or family history of pre-eclampsia, or a history of kidney disease, PCOS, hypertension, diabetes, autoimmune disease, sickle cell disease, or organ transplant; first-time moms; first pregnancies with a different father; obese moms; moms over age 40 or teen moms; moms by IVF; and moms expecting multiples, since decreased liver functioning plays a role in pre-eclampsia. This is especially true if you use astragalus with other liver-protective herbs such as dandelion and milk thistle (both believed safe for use during pregnancy). Kidney function is also aided by astragalus, making it a friend to pregnant women with a tendency to bladder infection or kidney stones.
Although many pregnant women find that their allergy symptoms are partially relieved during pregnancy, it is also a time when one is generally more reluctant to use over-the-counter and prescription medications for allergies, making astragalus an attractive, safe option for relief from allergies. Asthma sufferers can also look to astragalus for relief.
If you want to give astragalus a try, what is the best means to get it into your body? According to Richo Cech, the preferred method of consumption is a basic tea or decoction made from the fresh or dried root—ideally from roots dug in the fall of the second or third year of growth, or you can just add astragalus root to soups and consume it directly. If you don’t have access to the fresh or dried root, take astragalus in tincture form, using the dosage as recommended by the manufacturer, or as directed by your health care provider. Here’s to milk vetch: a powerhouse for pregnant moms!
Richo Cech, Making Plant Medicine, Horizon Herbs (Williams, OR) 2000
Jessie Hawkins, Herbalism for the Birth Professional Textbook, Thistle Publications (Franklin, TN) 2012
Q. "What is safe to take during pregnancy to treat a yeast infection? I know about cutting out sugar/carbs but are any over the counter treatments OK? Or other natural remedies? Will the infection hurt the baby at all?"
A. Yeast infections should not be harmful to your baby unless you have one when you are actually birthing your baby. In that case, it could infect your baby as he or she is born, possibly resulting in a yeast infection of the baby's mouth and therefore your nipples, called thrush. If you suspect you have a yeast infection, the following natural solutions may well be enough to self-treat; however, you should not use over the counter medications without your health care provider's go ahead, since they may not be safe for use during pregnancy.
1. Yeast is a dietary-related problem. All of us have yeast residing in our bodies, but it only becomes a problem when it is out of balance. Sugars and carbs "feed" the yeast and can get out of proportion, so that is why it is important to cut out sugar and sugar substitutes if you are struggling with a yeast overgrowth. Aim to satisfy your sweet tooth all (or mostly) from fruit, yet in as small of a quantity as you can stand. Fruit normally is rich in vitamins, so while fructose can also 'feed' yeast, fruit supplies you and baby with important nutrients, so is a smart choice in small quantities for cravings for sweets. Avoid fruit juices, since they are concentrated doses of sugars without the balancing of the pulp and skin which fill you up, naturally limiting over-consumption.
Yeast also loves dairy, so cut down on dairy while treating the yeast infection. During pregnancy, calcium intake is VERY important for your developing baby's bones and teeth, so when you cut down on dairy products, be extra diligent to increase your calcium intake from other sources such as deep green leafy veggies and nourishing herbs such as red raspberry leaf and nettles. (Those two herbs are pregnancy-safe--and indeed nourish you and baby-- and are excellent sources of calcium.)
Increase your garlic intake. A clove of garlic a day is a great anti-fungal.
2. Make sure you are taking a high-quality prenatal vitamin.
3. Take probiotics. During the time of the active infection, eat non-sweetened yogurt several times daily (homemade yogurt is best if you can)--acidophilus capsules are better. Depending on the brand, you can take a fairly high dose, but no matter whether you take yogurt or capsules, and no matter what dose you take, you need to take probiotics daily. If you go with capsules, take the lowest effective dose. If you feel gassy, bloated or nauseous, that's too much, but, again depending on the brand, 4-6 capsules daily is not too much. If you do feel gassy or bloated, decrease your daily dose by one tablet, though it might be hard to gauge if you also have morning sickness! If you have never taken probiotics before, start with the minimum recommended dose on the bottle and increase by one tablet per day, spread out over the day--until your symptoms are gone, you notice side effects, or until you are taking 10 billion organisms per day. Most women should be helped with a dose somewhere between 2 and 5 billion organisms per day.
4. Avoid dampness around the vagina. Dry thoroughly immediately after bathing. You can add yogurt or white vinegar or both to your bath.
5. Treat your spouse at the same time--yeast can infect men and be passed back to wives through intimate contact. Avoid intercourse during this time of the active yeast infection.
6. Pregnancy itself makes yeast overgrowth more likely, but antibiotic use greatly increases the likelihood of yeast infections, both vaginal and nipple yeast infections, called thrush. Avoid antibiotics during the pregnancy and birth if at all possible; they increase the likelihood of thrush afterwards, especially for women prone to yeast infections. Thrush infections make breastfeeding much more uncomfortable!
7. Other more desperate measures: prepare a douche with an unsweetened live culture yogurt (1 T.) to 1 quart water mixture. (Some advocate undiluted yogurt douches--I guess you will need to experiment with what works for you.) You can also use organic, high-quality cottage cheese soaked into a lady's pad and worn inside your underwear. Change several times per day. Use until you have no symptoms for 12 hours. (High-quality cottage cheese also has live cultures in it.) For vaginal itching relief, you can do the same type of soaked pad with yogurt and diluted white vinegar mixture.
Hope you feel better soon! If symptoms persist, make sure to contact your health care provider. All that itches is not necessarily yeast.
Pregnant mamas: make sure to get your D! As we move toward and through another Minnesota winter, it is good to be reminded of the importance of Vitamin D, not only for emotional health, but also for physical health. This article reported on a study of over 42,000 people which showed 13% increased risk for developing multiple sclerosis (MS) later in life if you were born in May vs. a 19% decreased risk if you were born in November--the researchers theorized that the difference in propensity to develop MS may be explained by differing levels of Vitamin D their mothers had while the study subjects were in utero. A major source of Vitamin D is simply exposure to sunlight, obviously something that is difficult to get in Minnesota in the winter. In addition to prenatal vitamin supplements, good nutritional sources of Vitamin D as reported in the article include oily fish, cheese, egg yolks and some kinds of mushrooms. I would add cod liver oil as a good source of Vitamin D. Today's cod liver oils are processed and flavored to remove the icky taste for which it was infamous in days gone by. I use the orange-flavored Nordic Naturals brand--something that has literally changed my life (that's another story). Yes, it is expensive, but you and your baby's health are worth it! I have a brochure about the benefits of cod liver oil for pregnancy and lactation which I would be happy to give to anyone at no cost--just call ahead and stop by our Family Center any afternoon between 2 and 5 pm--but as listed in brief here, some of the benefits of Vitamin D during pregnancy and lactation include:
Caution: To avoid the risk of hemorrhage, women who are taking blood thinners or have blood clotting disorders should not take cod liver oil unless advised to do so by your maternal health care provider.
The St. Croix